To explore the application value of endoscopic ultrasound fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment ofpatients with pancreatic cancer combined with obstructive jaundice.

Objective:To evaluate the diagnostic value of rapid on-site evaluation (ROSE) performed by endoscopists for solid pancreatic lesions requiring tissue for immunohistochemistry (IHC) staining with different approach of endoscopic ultrasound-guided tissue acquisition (EUS-TA).Methods:After screening 1 573 cases who underwent EUS-TA operation at the Endoscopy Center of Peking Union Medical College Hospital between August 2018 and October 2022, a total of 65 cases of solid pancreatic lesions whose diagnosis rely on IHC staining was collected and summarized with clinical data of each case. Among 65 cases, there were 46 cases of pancreatic neuroendocrine tumors (PNETs), 13 cases of pancreatic solid pseudo-papillary tumors (SPTs), and 6 cases of lymphomas and mesenchymal. Patients were categorized into ROSE group (36 cases) and non-ROSE group (29 cases) according to the presence or absence of endoscopists performed ROSE during EUS-TA operation. They were further divided into subgroups of FNA-ROSE (26 cases), FNB-ROSE (10 cases), FNA-non-ROSE (24 cases) and FNB-non-ROSE (5 cases) according to the type of EUS-TA. Diagnostic accuracy and IHC success rate were compared between different groups and subgroups. Binomial logistic multifactorial regression analysis was used to evaluate the influence of ROSE and EUS-TA type on diagnostic accuracy and IHC success rate.Results:There were no statistically significant differences between ROSE group and non-ROSE group in terms of age, gender, bilirubin level, CA19-9 level, lesion site, lesion size, composition ratio of diagnosis, and surgical rate. The differences in mean size of lesions, needle gauge, location of puncturation, and number of needle pass between subgroups were not statistically significant. The diagnostic accuracy was 88.9% in ROSE group and 79.3% in non-ROSE group, and the difference between the two groups was statistically significant ( P=0.023). The diagnostic accuracy of FNA-ROSE group was higher than that of FNA-non-ROSE group (88.5% vs 75.0%), but the difference was not statistically significant ( P>0.100). The differences in diagnostic accuracy and success rate of IHC between FNB-ROSE group and FNB-non-ROSE group were not statistically significant. Binomial logistic multifactorial regression analysis did not reveal any independent influences on diagnostic accuracy. Conclusions:ROSE performed by endoscopists improved diagnostic accuracy of EUS-TA in solid pancreatic lesions requiring IHC staining, and therefore is potentially valuable for improving the diagnostic efficiency of EUS-TA for such diseases.

Objective:To explore the clinical characteristics and outcomes of type 2 autoimmune pancreatitis (AIP) and compare with type 1 AIP.Methods:Clinical data of the patients diagnosed with type 2 AIP by the International Consensus on diagnostic criteria of AIP at Peking Union Medical College Hospital from January 2001 to December 2022 were retrospectively analyzed, and type 1 AIP patients diagnosed in Peking Union Medical College Hospital from January 1985 to December 2016 were collected as controls. The clinical symptoms, treatments and follow-ups were analyzed.Results:A total of 25 patients with type 2 AIP were included, of which 16 cases (64.0%) were pathologically confirmed cases (13 cases by endoscopic ultrasound puncture, 2 cases by surgery, and 1 case by interventional puncture), and 9 cases (36.0%) were suspected. The average age of onset was 40 years old. Most patients ( n=23, 92.0%) had abdominal pain along with emaciation to a various degree. Among them, 3 cases primarily presented as acute pancreatitis. Two cases were diagnosed after surgery for pancreatic masses. Eighteen cases were complicated with inflammatory bowel disease, including 16 cases with ulcerative colitis, one case with Crohn's disease, and one case with indeterminate colitis. All patients had typical imaging manifestations, including 13 cases (52.0%) with diffuse pancreatic enlargement, 12 cases (48.0%) with focal or multifocal pancreatic lesions, and 5 cases (20.0%) with simultaneous focal pancreatic masses and diffuse enlargement. All patients had normal serum IgG4 levels, anti-neutropil cytoplasmic antibodies (ANCA) positivity rate was 35.3% (6/17), and anti-nuclear antibody (ANA) positivity rate was 29.2% (7/24). Two surgical patients recovered well after surgery, and the other patients all achieved clinical and imaging relief after hormone therapy, and no recurrence was seen during follow-up. Compared with type 1 AIP, type 2 AIP had younger onset age, main manifestation as abdominal pain without jaundice, rare involvement with extra-pancreatic organs, the lesions mainly located in the intestine and normal IgG4 level with statistically significant differences. The recurrence rate of type 2 AIP was lower than that of type 1 AIP (0 vs 16%). Conclusions:Type 2 AIP has different clinical characteristics from type 1 AIP. Due to the lack of specific serum markers, the diagnosis is more difficult. It responds well to glucocorticoids and has a low recurrence rate.

Objective:To assess the efficacy of endoscopic transmural drainage, transpapillary drainage and their combination in reducing cyst recurrence in patients with disconnected pancreatic duct syndrome (DPDS).Methods:A retrospective study was conducted involving 22 patients diagnosed as having DPDS in Peking Union Medical College Hospital from January 2018 to December 2022. Patient data including clinical information, imaging characteristics, drainage technique, complications, and outcomes were extracted from the medical records and telephone follow-up.Results:There were 27 endoscopic treatments in 22 patients, which were categorized into 3 groups based on the procedural approach: transmural in 11 cases, transpapillary in 8, and the combination of both in 8. The combined drainage group exhibited a significantly higher drainage success rate (100.0%, 8/8) compared with the transpapillary group (50.0%, 4/8, P=0.012), with no significant difference compared with the transmural group [90.9% (10/11), P=0.621]. The one-year recurrence rate was significantly lower in the combined drainage group [0.0% (0/8)] than that in the transmural drainage group [55.6% (5/9), P=0.018], and transpapillary drainage alone [42.9% (3/7)] though it did not reach significance ( P=0.085). No significant differences were observed in treatment success rate [45.5% (5/11), 75.0% (6/8) and 87.5% (7/8), H=3.890, P=0.143], or complication incidence [54.5% (6/11), 75.0% (6/8) and 25.0% (2/8), H=3.909, P=0.142]. Conclusion:Transmural drainage combined with pancreatic duct stent placement results in satisfactory drainage of cystic fluid in the short term and significantly reduces one-year recurrence among patients with DPDS.

Objective:To investigate the role of endoscopic ultrasonography (EUS) in differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC).Methods:Data of 133 patients with AIP and 113 patients with PC who underwent EUS because of obstructive jaundice at Peking Union Medical College Hospital from January 2013 to December 2018 were retrospectively analyzed in the study, and were randomly divided into either a derivation sample or a validation sample using 1∶1 allocation according to the random number. In the derivation sample, 10 EUS characteristics were used to construct a prediction model to distinguish between AIP and PC, in which predictors were identified by multivariate stepwise logistic regression analysis and predictive efficacy was evaluated by receiver operating characteristics (ROC) curve analysis. The predictive efficacy was assessed in the validation sample. In view of the subjectivity in the judgment of diffuse/focal hypoechogenicity, 2 prediction models were designed in order to avoid bias.Results:By multivariate stepwise logistic regression analysis, diffuse hypoechogenicity ( OR=591.0, 95% CI: 98.8->999.9, P<0.001) and vessel involvement ( OR=11.9, 95% CI: 1.4-260.2, P=0.023) were identified as statistically significant predictors for distinguishing AIP from PC. EUS characteristics excluding diffuse/focal hypoechogenicity were stepped by logistic regression, which showed that hyperechoic foci/strands ( OR=177.3, 95% CI: 18.7->999.9, P<0.001), pancreatic duct dilation ( OR=60.5, 95% CI: 6.2->999.9, P=0.004), bile duct wall thickening ( OR=35.4, 95% CI: 3.7->999.9, P=0.009), lymphadenopathy ( OR=16.8, 95% CI: 1.7-475.2, P=0.038) and vessel involvement ( OR=22.7, 95% CI: 2.0-725.7, P=0.028) were statistically significant predictors to distinguish the two diseases. Both prediction models were built in the derivation sample, with area under the ROC curve of 0.995 and 0.979 respectively. In the validation sample, sensitivity, specificity, accuracy, positive predictive value and negative predictive value of both prediction models were all >90% by using the optimal cutoff value. Even for discrimination between focal AIP and PC, sensitivity and accuracy of both models were >90%, and specificity, positive predictive value and negative predictive value were all >85%. Conclusion:The 2 prediction models have good differential predictive value, and EUS is a useful tool to differentiate between AIP and PC.

Objective:To compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol (PEG) electrolyte powder for colonoscopy bowel preparation.Methods:A total of 283 randomized patients from 9 centers in China taking OSS ( n=143) or PEG ( n=140) using two-day split bowel preparation regimen received colonoscopy and assessment. The primary index was the bowel preparation success rate [global Boston bowel preparation scale (BBPS)≥ 6 by independent assessment center]. Secondary indices included BBPS global and segmental scores, investigator satisfaction (5-point Likert scale) with the quality of bowel preparation, patient satisfaction assessed by questionnaires, and patient tolerance assessed by Sharma scale. Compliance and safety were compared between the two groups. Results:The bowel preparation success rates were 100.0% for OSS and 99.3% for PEG [adjusted difference 0.7% (95% CI: -5.3% - 6.7%), P<0.001 for non-inferiority]. The BBPS global score in OSS group was significantly higher than that in PEG group (8.1 VS 7.7, P<0.001). The segment BBPS scores were also higher in OSS group than those in PEG group for all 3 segments (right colon: 2.4 VS 2.3, P=0.002; transverse colon: 2.8 VS 2.7, P=0.018; left colon: 2.8 VS 2.7, P=0.007). Investigator Likert score in the OSS group was significantly higher than that in the PEG group (2.6 VS 2.3, P<0.001). There was no significant difference in compliance between OSS and PEG, except for the second dose (90.9% VS 82.6%, P=0.039). There was no significant difference in patient satisfaction, Sharma score or proportion of patients with tolerance-related symptoms between the two groups. Safety was comparable between the two groups, and all adverse events were mild to moderate. Conclusion:OSS has comparable efficacy with PEG, with higher BBPS scores in all segments, better investigator satisfaction, better compliance in split dose, and comparable patient tolerance and safety.

Objective:To investigate the predictive value of mucosal vascular pattern (MVP) in colonic epithelial proliferation of patients with ulcerative colitis (UC) under narrow-band imaging (NBI) colonoscopy.Methods:From December 1, 2012 to January 31, 2015, 42 patients with UC visiting Peking Union Medical College Hospital and receiving NBI colonoscopy were selected. The images of 119 colorectal lesions of all the patients under the conventional white light and NBI endoscopy were collected and at least one biopsy of each lesion was obtained for histological assessment. All the endoscopic images were randomly allocated to one endoscopist (associated chief physician) for the MVP and the Mayo endoscopic score (MES) assessment. The degree of mucosal inflammation was graded from 0 to 4 according to the histological colitis score. The degree and distribution of Ki-67 expression were evaluated by immunohistochemical staining. Student-Newman-Keuls (SNK)- q test and Spearman rank correlation analysis were used for statistical analysis. Results:Under NBI colonoscopy, the MVP of patients with UC was divided into clear type, obscure type and absent type. According to the morphology of mucosal glandular duct, the absent type was divided into crypt opening subtype and villous subtype. There was a positive correlation between MVP under NBI mode and the MES under white light mode ( r=0.80, P<0.001). The Ki-67 staining indexes of MVP obscure type, absent type, crypt opening subtype and villous subtype of absent type were all higher than that of MVP clear type (30.3±12.8, 45.9±12.5, 45.5±12.1 and 46.3±13.1 vs. 15.6±7.3), and the differences were statistically significant (SNK- q test, all P<0.001); and the Ki-67 staining indexes of MVP absent type, crypt opening subtype and villous subtype of MVP absent type were all higher than that of MVP obscure type, and the differences were statistically significant (SNK- q test, all P<0.001). There was a positive correlation between the MVP type under NBI colonoscopy and the distribution of Ki-67 expression ( r=0.49, P<0.001). The Ki-67 staining indexes of inflammation grade 2, 3 and 4 were higher than that of grade 1 (28.8±10.9, 40.2±11.6 and 49.5±10.3 vs. 17.1±8.4), and the difference was statistically significant (SNK- q test, all P<0.001); the Ki-67 staining indexes of inflammation grade 3 and 4 were higher than that of grade 2, and Ki-67 staining index of inflammation grade 4 was higher than that of grade 3, and the differences were statistically significant (SNK- q test, all P<0.001). The distribution of Ki-67 expression was positively correlated with the degree of histological inflammation ( r=0.56, P<0.001). Conclusions:The MVP under NBI colonoscopy may indirectly predict the colonic epithelial proliferation of patients with UC, which may be closely related to the degree of mucosal inflammation.

Objective:To evaluate the development and application of gastrointestinal endoscopy technology in Beijing-Tianjin-Hebei (BTH) region from 2016 to 2020, and the impact of the corona virus disease 2019 (COVID-19) epidemic on gastrointestinal endoscopy screening and lesion detection rate of medical institutions.Methods:Data of gastroscopy and colonoscopy cases from 26 cooperative institutions in BTH Region Gastrointestinal Endoscopy Medical Association from January 2016 to December 2020 were collected by questionnaire. The number of gastrointestinal endoscopy, the detection of main lesions (including upper gastrointestinal malignant tumors, early gastric cancer and colon cancer), and the number of endoscopic treatment were retrospectively analyzed by year.Results:From 2016 to 2019, the number of gastroscopy and colonoscopy showed a yearly increasing trend with an annual growth rate of over 10%. Compared with 2019, the number of gastroscopy and colonoscopy decreased by 10.86% and 8.29%, respectively, in 2020 due to the impact of the epidemic. The annual detection rates of upper gastrointestinal malignant tumors, early gastric cancer and colon cancer were on a rise, from 7.22%, 1.49% and 8.98% in 2016 to 9.87%, 2.71% and 12.04% in 2020, respectively. The number of gastroscopic mucosal resection, submucosal dissection and colonoscopic endoscopic submucosal dissection increased yearly, from 2 132, 300 and 217 cases in 2016 to 5 466, 872 and 560 cases in 2020, respectively.Conclusion:The Medical Association has promoted the expansion of endoscopic screening and the application of endoscopic treatment techniques, resulting in a continuous increase in the endoscopy detection rate and early cancer diagnosis rate in the BTH region. The sharp decrease of gastrointestinal endoscopy procedures and the increase in the lesion detection rate in 2020 reflect the impact of epidemic COVID-19 on detection of gastrointestinal cancers.

Objective:To explore the preoperative diagnostic value of endoscopic ultrasonography (EUS) for intraductal papillary mucinous neoplasms (IPMN).Methods:Data of 62 patients with IPMN confirmed by pathology who underwent EUS before surgery from 2008 to 2018 in Peking Union Medical College Hospital were analyzed. Characteristics that could distinguish low-grade dysplasia (LGD), high-grade dysplasia (HGD) and invasive carcinoma (IC) were explored. A scoring system based on EUS findings was established to determine the preoperative pathology of IPMN by using logistic model.Results:Of the 62 patients, 15 (24.2%) were diagnosed as having LGD, 20 (32.3%) HGD and 27 (43.5%) IC. Univariate analysis showed that the size of mural nodules and width of main pancreatic duct (MPD) were predictive factors for IPMN pathology. The possibility of higher pathological grading would increase 8% for every 1 mm increment in mural nodules. Multivariate analysis showed that only mural nodules≥5 mm ( OR=7.31, 95% CI : 2.49-21.40, P<0.001) was an independent risk factor to distinguish LGD, HGD and IC. Mural nodules≥5 mm, main pancreatic duct (MPD)≥10 mm and mural nodules <5 mm were assigned 2 points, 1 point and 1 point, respectively. The sensitivity, specificity, and area under receiver operator characteristic curve (AUC) of the EUS scoring system to distinguish benign and malignant IPMN were 0.830, 0.867, and 0.867, respectively. Conclusion:Preoperative EUS helps to distinguish LGD, HGD and IC. The size of mural nodules and the width of MPD are vital risk factors to distinguish benign and malignant IPMN.

Objective:To investigate the diagnostic value of conventional endoscopy (CE) and endoscopic ultrasonography (EUS) for invasion depth prediction of superficial gastric cancer.Methods:A total of 84 patients with superficial gastric cancer underwent both CE and EUS before treatment at Beijing Shijitan Hospital from January 2011 to December 2019. The patients were divided into CE affirmation group (47 cases) and CE non-affirmation group (37 cases) according to the endoscopist′s affirmation in the results of CE. Diagnostic accuracy of each method was compared with the histology of the resected specimen. And influential factors for the diagnosis were analyzed.Results:The overall accuracy in determining the invasion depth of superficial gastric cancer was 73.8% (62/84) for CE and 81.0% (68/84) for EUS respectively ( P=0.092). In CE affirmation group, the diagnostic accuracy of CE was significantly higher than that in the CE non-affirmation group [93.6% (44/47) VS 48.7% (18/37), χ2=21.656, P<0.001]. Twenty (23.8%) of 84 lesions were over-staged by CE, dignosed as surgical candidates, and 8 (40.0%) of the over-staged diagnosis were modified by additional EUS assessment. Multivariate logistic analysis showed that influential factors associated with observer affirmation included uneven surface of lesion ( OR=5.076, 95% CI: 1.628-15.821, P=0.005), margin elevation ( OR=3.831, 95% CI: 1.238-11.857, P=0.020) and undifferentiated carcinoma ( OR=6.887, 95% CI: 1.882-25.204, P=0.004). Conclusion:For patients of CE affirmation in the invasion depth, the diagnostic accuracy is high. For those of non-affirmation, additional EUS can improve the diagnostic accuracy and help to develop a more appropriate regime.